Advance Dental Management

NPI #1417020454 in Mukwonago, Wisconsin

Provider Information

NPI Number: 1417020454
Entity Type: Organization
Organization Name: Advance Dental Management
Primary Specialty: Dentist - General Practice
Enumeration Date: Nov 16, 2006
Last Updated: Aug 22, 2020

Practice Location

Address: 720 N ROCHESTER ST
Address 2: SUITE 203
City: Mukwonago
State: Wisconsin
ZIP Code: 53149-1188
Phone: (262) 363-2220

Authorized Official

Name: GENIE KUBLE
Title: CONTACT OFFICER
Phone: (920) 450-0157

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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